Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00064
f;
AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/17/2011
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 100
Project: Lincoln Heritage Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project Description: Install low voltage for card reader.
Contractor: ALLIED FIRE & SECURITY Owner: GK TRIANGLE CORPORATE PARK III L
530 NE COUCH ST BB# 73- 1771- GK1130
PORTLAND, OR 97232 CBRE
PO BOX 2096
WARREN, MI 48090
PHONE: 503 - 231 -9550 PHONE:
FAX: 503 - 231 -9551
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/17/2011 $75.00
12% State Surcharge - Electrical 03/17/2011 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: Y Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTE N: Oreg• • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 0 through OAR 9 •- • -00 • .. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu By: t.- 4° Permittee Signature: I
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
03-16-11 07:59 FROM- T-975 P0001/0003 F-352
Electrical Permit Application volt oFficE t sE, °NIA
City of Tigard Received .0
D ! Q mower] '
1 111 4 - . 13125 SW Hall Blvd.. Tigard, OR 97223 • Permit No.: 0 _
Phone: 503.718,2439 Fax: 503.598.1960
Plan Review
Datc/B ; Other Permit!
_..
Inspection Line: 503.639.4175 r 0 \\
Date Ready/Ey; lurit: 0 See Page 2 for
i i (:. A P. I)
Internet: www,tigard-or.gov 6 ' n N, C3 Notified/Method; Supplemental Information .
,, , i■ '-•,,
2 : ; .:' '' ' : '., . A I s W
0 New construction ArAddition/alteration/replacement Please check all that apply (submit 2 sets of plans vditemg checked below);
0 Service or feeder 400 amps or more 0 Building over three stories.
ID Demolition D Other: where the available fault cturent 0 Marinas and boatyards.
''.:: i '',:=;; l''''•';' :i''''''F t oy , ',=';',:-,,..: ,! exceeds 10.000 amps at 150 volts or 0 Floating buildings. .
less to pound. or exceeds 14,000 fl Cornmercial-use agricultural
0 I - and 2-family dwelling MCommercial/industrial 0 Accessory building amps for ali other installations, buildings.
0 Multi-family 0 Master builder D Other: 0 Fire pump. u Installation of 75 KVA Or
t o it booto :oft . 06 , tio ,,,,. „„,,,,.:,,, :., ,..,.,. ;;;:, ,,,,„ 0 Emergency system. larger separately derived system.
nio
I1 004( 100HP or more. occupancy.
Job no.: . 5 40 Job site address: (-3 zzi 1 ,j 6 ••17
1:1Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: - M y ketp , OP, /727--1 01 facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts noinhaal.
Suite/bldgiapt, no.: (00 Project name:
bal., A) theiro - eA Re00,E , OService or feeder 600 amps or more.
',.: Sd
Cross street/directions to job site: 1._ 5 s A. 61 213 Desaignen I city I Fee, .7 Total I •!.
New residential single- or multitamily dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. addl 500 sq. ft. or portion 33.92 1 .•
Tax map/parcel no.:
Limited energy. residential
:'...;;l: ';',:;,';` ' ':!.;,:
OF i • : : ' ,: -..,T : ,:,..],,,= (with above sq. ft.) 75.00 2
'---- Limited energy, multi-family ,
lnA-1■11 (ALI pl c.04 Puifir s Am -.,,,, -.K.,_ residential (with above sq. ft.) 75.00 2 •
4 ' Services or fcedersins(Olation alteration, and/or relocation
200 amps or less 100.70 2
Il 201 amps to 400 ampS 133.56 2
401 amps to 600 amps 200.34 2
1. ' l annie-OL/J AVglikte, Nttiv at- rivme ...
601 amps to 1,000 amps 301.04 2
Address: /rat s w Le. -yuk Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: 11 () 04 qin.3 relotation
i •
Phone: Tr/ ) Z y („( _ an 1 Pax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
•
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee, •
' ii.'iT'',..: .10';. .:::&:•,.;•.; j., :':...:. :::';'.'• '•:': ;';'' CI , 1 . t T "cl,: :_01. 7,42 2
each branch circuit
Business name: AtU F t ; e4. +, s eiv B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: 2 ON branch circuit •
Each add'l branch circuit IM1112111111111111 2
Address: -- Nit o sifloel- Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 1;biki oi l, 9-ra9z. dwelling, service and/or feeder 67,84 2
Phone: 0'03 ) in - Los (4 Fax: : ( 51 7 / ) - ite ?i 1 - 955-/ Reconnect only , 67,84 2
Pomp or irrigation circle 67.84 2
E XAre4tit Mi.4 . . • eoci Si or outline lighting 67.84
n ..:.Otitti40.00 .''.,';•••,..;. ;• '... ..'::' ;c:%;;*''..,,,;.": si & or li m i te d - energy
panel, alteration, or extension.
Business name: A i ; 4 ( 11) . _ PIN _.1 5( to\f44-471 . . .. _...
Each additional inspection over allowable in of the above 2
Address: 5 k s i 4 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66,25/ hr
City/State/ZIP: ,... r u i t 0,11.5 IV ? Z. Industrial plant (1 hr milt) 78.18( hr
/
Phone: (In ) /72 - Fax: I Fax; ( 507 ) 2.71- 15-5-) Inspections for which no fee is
. s cificall listed (1/2 hr lrlih) 90.00/ hr •
CCB Lic.: 6 yq 4, 5 -- Electrical Lie.; ? Cu, uprv. Lic.: taz cA
6 .
Subtotal; 75 • 00
Suprv. Electrician signature, required: - -
Plan review (25% of permit
- Pl •
Print name: •
i I • CPO\
A Date; .7 , /11 State surcharge (12% of permit fee): q. op
Authorized signature.
- '■a * 4t- TOTAL PERMIT P1313; 4 gy. CO
Th permit application expires if a permit is not obtained within 180 •
days after it has been accepted
Print name: "A.e AA , APB& I Date: 0 M / ( I * Number of inspections allowed per permit as complete. .
maiuklinr‘Pennaglal,C-PemiltApp,doc 07/01ii0 440-4613101/05/COmiwEE
03- 16 -'11 07: 59 FROM- T -975 P0002/0003 F -352
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ I-IVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting* �
❑ Protective Signaling 4--c g g 5 (? i /e-e (
p. Other Ztui'C 64 1
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1auildi0g\Pern OP-14- PemuinppAx 01,01/10